Giant Renal Cyst Mimicking Ascites on Abdominal Ultrasonography

An article describes diagnostic difficulties in patient with giant renal cyst, erroneously diagnosed as ascites on ultrasonographic examination. Patient was initially suspected to have disseminated intraabdominal malignancy. Abdominal paracentesis of supposed ascites was performed. The diagnosis of giant renal cyst was finally made by CT and patient was treated surgically. The limitations of ultrasonographic examination are pointed out are and a brief review of similar cases is given

Clinical Use of Magnetic Resonance Imaging for the Diagnosis of Acute Myocardial Infarction in the Survivors of Cardiac Arrest

The ventricular arrhythmias with underlying coronary artery disease are a leading cause of sudden cardiac death (SCD). While the SCD survivors with proven AMI are considered to be at low risk of SCD recurrence, those without the evidence of AMI represent a high risk group that benefits from implantable cardioverter defibrillator. Therefore, the evaluation of SCD survivors for the presence of acute myocardial infarction (AMI) as a triggering factor of cardiac arrest is essential. In SCD survivors, the use of the standard diagnostic criteria of AMI may be difficult, as both serum cardiac biomarkers and electrocardiogram can be influenced by previous cardiac arrest. A novel technique that may be used for the diagnosis of AMI is magnetic resonance imaging (MRI). We report its use in four patients after cardiopulmonary resuscitation where the diagnosis of AMI could not be definitely established or excluded by means of other diagnostic procedures

Comparison of Magnetic Resonance Imaging and Cardiac Catheterization in Patients with Suspected Severe Aortic Stenosis

Objective. Magnetic resonance imaging (MRI) is a novel technique used in the assessment of aortic stenosis. The aim of the study was to compare MRI and cardiac catheterization (CAT) that is still considered to be a “golden standard” in this indication. Methods. Thirty-four patients referred to CAT for the evaluation of aortic stenosis were enrolled into the study. CAT was performed according to the standardized protocol. Cardiac output was measured by thermodilution and mean aortic gradient was determined using simultaneous blood pressure measurement in aorta and left ventricle. MRI was performed within the period of 3 weeks after CAT. True FISP sequence with retrospective ECG gating was used for the imaging of the aortic valve orifice. Planimetry of the aortic valve area (AVA) was performed at the time of maximal opening of the valve during systole. Results. MRI enabled the measurement of AVA in all patients enrolled. Mean AVA defined by CAT and MRI were 0,97 (±0,41) cm2 and 1,38 (±0,55) cm2, respectively. The correlation between the evaluated methods was statistically significant (p=0,003), but not very strong (r=0,43). The comparison of both methods in the identification of the severe aortic stenosis was characterized by kappa value of 0,331. Conclusion. Our study shows low agreement between cardiac catheterization and magnetic resonance imaging in the assessment of aortic stenosis. However, MRI might have a role in the diagnostic algorithm in patients with suspected severe aortic stenosis and moderate mean aortic gradient or concomitant valvular insufficiency

Comparison of Duplex Ultrasonography and Magnetic Resonance Imaging in the Detection of Significant Renal Artery Stenosis

Objective: The aim of our study was to evaluate duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in detection of haemodynamically significant renal artery stenosis (RAS). Methods: The study included patients with high clinical suspicion of renovascular hypertension (RVH). The imaging of renal arteries was performed by DUS, MRA and digital subtraction angiography (DSA). Significant RAS was defined as maximum systolic velocity ≥ 180 cm/sec (DUS) or as 60% reduction of the endoluminal arterial diameter (MRA, DSA). The results of DUS and MRA were assessed in respect to the results of DSA. Results: Arterial supply of 186 kidneys in 94 patients was evaluated. DSA revealed significant RAS in 61 kidneys evaluated. DUS was not able to examine arterial supply in 18 kidneys of 13 patients. In the detection of significant RAS, DUS was characterized by sensitivity and specificity of 85 % and 84 %. MRA achieved satisfactory imaging quality in all but one kidney evaluated. The sensitivity and specificity of MRA in the detection of significant RAS was 93 % and 93 %, respectively. Conclusion: In patients with high clinical probability of RVH, MRA proved to be more reliable and superior in both sensitivity and specificity to DUS in the detection of significant RAS

Long-term relationship between unattended automated blood pressure and auscultatory BP measurements in hypertensive patients

Aims: Unattended automated office blood pressure (uAutoOBP) has attracted more attention since SPRINT trial had been published. However, its long-term relationship to attended office blood pressure (AuscOBP) is not known. Material and methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centers. All subjects attended four clinical visits three months apart. uAutoOBP was measured with the BP Tru device; AuscOBP was measured three times with auscultatory method by the physician. 24-hour ambulatory blood pressure monitoring (ABPM) was performed within one week from the second clinical visit. Results: Data on 112 subjects aged 65.6 ± 10.8 years with mean AuscOBP 128.2 ± 12.2/78.5 ± 10.3 mm Hg are reported. Across the four clinical visits, the uAutoOBP was by 10.1/3.7 mm Hg lower than AuscOBP and the mean difference was similar during all four visits (P≥.061). Both uAutoOBP and AuscOBP had similar intra-individual variability during study follow-up as demonstrated by similar intraclass correlation coefficients (ICC, for systolic ICC = 0.50, for diastolic ICC = 0.72). However, the intra-individual variability of the systolic AuscOBP and uAutoOBP difference was high as demonstrated by low ICCs for absolute (ICC = 0.17 [95%CI, 0.09 – 0.25]) and low κ coefficients for categorized differences (κ ≤ 0.16). The main determinant of AuscOBP-uAutoOBP difference was AuscOBP level. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM. Conclusions: Although mean AuscOBP-uAutoOBP differences were relatively similar across the four clinical visits, intra-individual variability of this difference was high. The AuscOBP-uAutoOBP difference was poor tool to identify hypertension control categories defined on the basis of AuscOBP and ABPM. Therefore, uAutoOBP cannot be used as a replacement for ABPM

In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring

<p><b>Aims:</b> Several papers reported that unattended automated office blood pressure (uAutoOBP) is closely related to daytime ambulatory blood pressure monitoring (ABPM). In the present study, we aim to study uAutoOBP and its relation to 24-hour ABPM and ABPM variability.</p> <p><b>Material and methods:</b> Stable treated hypertensive subjects were examined in two Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP three times with auscultatory method (AuscOBP) by the physician. ABPM was performed within one week from the clinical visit.</p> <p><b>Results:</b> Data on 98 subjects aged 67.7 ± 9.3 years with 24-hour ABPM 120.3 ± 10.6/72.7 ± 7.9 mm Hg are reported. uAutoOBP was lower than 24-hour (by −5.2 ± 11.3/−0.5 ± 6.9 mm Hg) and daytime (by −6.7 ± 12.82.4 ± 8.0 mm Hg) ABPM and the individual variability of the difference was very large (up to 30 mm Hg). The correlation coefficients between ABPM and uAutoOBP were similar compared to AuscOBP (<i>p</i> ≥ .17). Variability of uAutoOBP, but not AuscOBP, readings during one clinical visit was related to short-term blood pressure variability of ABPM. The difference between AuscOBP and uAutoOBP was larger in patients with white-coat effect compared to other blood pressure control groups (25.1 ± 7.0 vs. 2.2 ± 10.3 mm Hg; <i>p</i> = .0036).</p> <p><b>Conclusions:</b> Our study shows that uAutoOBP is not good predictor of ambulatory blood pressure monitoring, not even of the daytime values. It might, however, indicate short-term blood pressure variability and, when compared with AuscOBP, also detect patients with white-coat effect.</p